|
ENDURANT AAA BIFUR 23*13*166
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*13*166
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*16*124
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*16*124
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*16*145
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*16*145
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*16*166
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*16*166
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*13*124
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*13*124
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*13*145
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*13*145
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*13*166
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*13*166
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*16*124
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*16*124
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*16*145
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*16*145
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*16*166
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 25*16*166
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 28*13*124
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 28*13*124
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 28*13*145
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 28*13*145
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 28*13*166
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
